Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

Enju Liu; Dongqing Wang; Anne M. Darling; Nandita Perumal; Molin Wang; Tahmeed Ahmed; Parul Christian; Kathryn G. Dewey; Gilberto Kac; Stephen Kennedy; Vishak Subramoney; Brittany Briggs; Wafaie W. Fawzi; members of the GWG Pooling Project Consortium

doi:10.1093/ajcn/nqac259

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

Enju Liu, Dongqing Wang, Anne M. Darling, Nandita Perumal, Molin Wang, Tahmeed Ahmed, Parul Christian, Kathryn G. Dewey, Gilberto Kac, Stephen Kennedy, Vishak Subramoney, Brittany Briggs, Wafaie W. Fawzi, members of the GWG Pooling Project Consortium

Research output: Contribution to journal › Article › Scientific › peer-review

5 Citations (Scopus)

4 Downloads (Pure)

Abstract

Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I², stratified analysis, and meta-regression. Results: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

Original language	English
Pages (from-to)	1864-1876
Number of pages	13
Journal	American Journal of Clinical Nutrition
Volume	116
Issue number	6
DOIs	https://doi.org/10.1093/ajcn/nqac259
Publication status	Published - 2022
Publication type	A1 Journal article-refereed

Funding

Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Members of the GWG Pooling Project Consortium: Seth Adu-Afarwuah and Anna Lartey (Department of Nutrition and Food Science, University of Ghana, Legon), Abu Ahmed Shamim and Malay Kanti Mridha (Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University), Shams Arifeen (International Center for Diarrheal Disease Research, Bangladesh), Per Ashorn and Ulla Ashorn (Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital), Zulfiqar A Bhutta (Centre for Global Child Health, Hospital for Sick Children and Institute for Global Health & Development, The Aga Khan University), Yue Cheng (Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center), Anthony M Costello (Global Health and Sustainable Development, UCL Institute for Global Health), Henrik Friis (Department of Nutrition, Exercise and Sports, University of Copenhagen), Exnevia Gomo (Faculty of Medicine and Health Sciences, University of Zimbabwe), Rebecca Grais (Epicentre, Paris), Ousmane Guindo (Epicentre Niger), K Michael Hambidge and Nancy F Krebs (University of Colorado School of Medicine), Lieven Huybregts (Department of Food Technology, Safety and Health, Ghent University and Poverty, Health and Nutrition Division, International Food Policy Research Institute), Sheila Isanaka (Epicentre, Paris and Departments of Nutrition and Global Health and Population, Harvard TH Chan School of Public Health), Patrick Kolsteren and Carl Lachat (Department of Food Technology, Safety and Health, Ghent University), Steven C LeClerq, Kerry Schulze, Keith P West Jr, and Lee Wu (Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University), Kenneth Maleta (School of Public Health and Family Medicine, College of Medicine, University of Malawi), Dharma S Manandhar [Mother and Infant Research Activities (MIRA)], Reynaldo Martorell and Usha Ramakrishnan (Hubert Department of Global Health, Rollins School of Public Health, Emory University), Susana L Matias (Department of Nutritional Sciences and Toxicology, University of California, Berkeley), Elizabeth M McClure (RTI International), Sophie E Moore (Department of Women and Children's Health, King's College London; St Thomas’ Hospital, London; and MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), David Osrin (UCL Institute for Global Health), Andrea B Pembe (Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences), Andrew M Prentice (MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), Juan Rivera (National Institute of Public Health, Mexico), Sajid Soofi (Centre of Excellence in Women and Child Health, The Aga Khan University), Willy Urassa (Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences), and Lingxia Zeng and Zhonghai Zhu (Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center). We thank Sun-Eun Lee, Jian Yan, and Karen T Cuenco at the Bill and Melinda Gates Foundation for their support of the Gestational Weight Gain Pooling Project. We thank Nita Bhandari at the Society for Applied Studies for her support as a member of the technical advisory group. The authors’ responsibilities were as follows—EL, DW, AMD, NP, MW, and WWF: designed the study (project conception, development of the overall research plan, and study oversight) with substantial input from technical advisory group members (PC, KGD, GK, SK, and TA); all members of the GWG Pooling Project Consortium: contributed data, provided feedback on the study methods and interpretation of the findings, and critically reviewed the manuscript for important intellectual content; VS, BB, and DW: provided technical support and coordination for data collection, data management, and harmonization; DW, EL, AMD, and NP: had access to the pooled data; EL: led the statistical analysis and drafted and revised the manuscript; EL and WWF: have primary responsibility for the final content; and all authors: contributed to, read, and approved the final manuscript. Data described in the article, code book, and analytic code will be made available upon request pending application and approval. Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Author disclosures: The authors report no conflicts of interest. Supplemental Material, Supplemental Tables 1–3, and Supplemental Figures 1–14 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/.

Keywords

gestational weight gain
low- and middle-income countries
meta-analysis
multiple micronutrient supplements
randomized controlled trials
small-quantity lipid-based nutrient supplements

ASJC Scopus subject areas

Medicine (miscellaneous)
Nutrition and Dietetics

Access to Document

10.1093/ajcn/nqac259

Effects of prenatal nutritional supplements on gestational weight gain..._AM versionAccepted author manuscript, 104 KBLicence: CC BY-NC-ND

https://urn.fi/URN:NBN:fi:tuni-202305105537Licence: CC BY-NC-ND

Cite this

Liu, E., Wang, D., Darling, A. M., Perumal, N., Wang, M., Ahmed, T., Christian, P., Dewey, K. G., Kac, G., Kennedy, S., Subramoney, V., Briggs, B., Fawzi, W. W., & members of the GWG Pooling Project Consortium (2022). Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data. American Journal of Clinical Nutrition, 116(6), 1864-1876. https://doi.org/10.1093/ajcn/nqac259

@article{d3b3df8067e54eec9a56bd68d6e5223a,

title = "Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data",

abstract = "Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. Results: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.",

keywords = "gestational weight gain, low- and middle-income countries, meta-analysis, multiple micronutrient supplements, randomized controlled trials, small-quantity lipid-based nutrient supplements",

author = "Enju Liu and Dongqing Wang and Darling, {Anne M.} and Nandita Perumal and Molin Wang and Tahmeed Ahmed and Parul Christian and Dewey, {Kathryn G.} and Gilberto Kac and Stephen Kennedy and Vishak Subramoney and Brittany Briggs and Fawzi, {Wafaie W.} and {members of the GWG Pooling Project Consortium} and Per Ashorn and Ulla Ashorn",

note = "Funding Information: Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Funding Information: Members of the GWG Pooling Project Consortium: Seth Adu-Afarwuah and Anna Lartey (Department of Nutrition and Food Science, University of Ghana, Legon), Abu Ahmed Shamim and Malay Kanti Mridha (Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University), Shams Arifeen (International Center for Diarrheal Disease Research, Bangladesh), Per Ashorn and Ulla Ashorn (Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital), Zulfiqar A Bhutta (Centre for Global Child Health, Hospital for Sick Children and Institute for Global Health & Development, The Aga Khan University), Yue Cheng (Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center), Anthony M Costello (Global Health and Sustainable Development, UCL Institute for Global Health), Henrik Friis (Department of Nutrition, Exercise and Sports, University of Copenhagen), Exnevia Gomo (Faculty of Medicine and Health Sciences, University of Zimbabwe), Rebecca Grais (Epicentre, Paris), Ousmane Guindo (Epicentre Niger), K Michael Hambidge and Nancy F Krebs (University of Colorado School of Medicine), Lieven Huybregts (Department of Food Technology, Safety and Health, Ghent University and Poverty, Health and Nutrition Division, International Food Policy Research Institute), Sheila Isanaka (Epicentre, Paris and Departments of Nutrition and Global Health and Population, Harvard TH Chan School of Public Health), Patrick Kolsteren and Carl Lachat (Department of Food Technology, Safety and Health, Ghent University), Steven C LeClerq, Kerry Schulze, Keith P West Jr, and Lee Wu (Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University), Kenneth Maleta (School of Public Health and Family Medicine, College of Medicine, University of Malawi), Dharma S Manandhar [Mother and Infant Research Activities (MIRA)], Reynaldo Martorell and Usha Ramakrishnan (Hubert Department of Global Health, Rollins School of Public Health, Emory University), Susana L Matias (Department of Nutritional Sciences and Toxicology, University of California, Berkeley), Elizabeth M McClure (RTI International), Sophie E Moore (Department of Women and Children's Health, King's College London; St Thomas{\textquoteright} Hospital, London; and MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), David Osrin (UCL Institute for Global Health), Andrea B Pembe (Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences), Andrew M Prentice (MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), Juan Rivera (National Institute of Public Health, Mexico), Sajid Soofi (Centre of Excellence in Women and Child Health, The Aga Khan University), Willy Urassa (Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences), and Lingxia Zeng and Zhonghai Zhu (Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center). We thank Sun-Eun Lee, Jian Yan, and Karen T Cuenco at the Bill and Melinda Gates Foundation for their support of the Gestational Weight Gain Pooling Project. We thank Nita Bhandari at the Society for Applied Studies for her support as a member of the technical advisory group. The authors{\textquoteright} responsibilities were as follows—EL, DW, AMD, NP, MW, and WWF: designed the study (project conception, development of the overall research plan, and study oversight) with substantial input from technical advisory group members (PC, KGD, GK, SK, and TA); all members of the GWG Pooling Project Consortium: contributed data, provided feedback on the study methods and interpretation of the findings, and critically reviewed the manuscript for important intellectual content; VS, BB, and DW: provided technical support and coordination for data collection, data management, and harmonization; DW, EL, AMD, and NP: had access to the pooled data; EL: led the statistical analysis and drafted and revised the manuscript; EL and WWF: have primary responsibility for the final content; and all authors: contributed to, read, and approved the final manuscript. Data described in the article, code book, and analytic code will be made available upon request pending application and approval. Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Author disclosures: The authors report no conflicts of interest. Supplemental Material, Supplemental Tables 1–3, and Supplemental Figures 1–14 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/. Publisher Copyright: {\textcopyright} 2022 American Society for Nutrition.",

year = "2022",

doi = "10.1093/ajcn/nqac259",

language = "English",

volume = "116",

pages = "1864--1876",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "American Society for Nutrition",

number = "6",

}

Liu, E, Wang, D, Darling, AM, Perumal, N, Wang, M, Ahmed, T, Christian, P, Dewey, KG, Kac, G, Kennedy, S, Subramoney, V, Briggs, B, Fawzi, WW & members of the GWG Pooling Project Consortium 2022, 'Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data', American Journal of Clinical Nutrition, vol. 116, no. 6, pp. 1864-1876. https://doi.org/10.1093/ajcn/nqac259

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data. / Liu, Enju; Wang, Dongqing; Darling, Anne M. et al.
In: American Journal of Clinical Nutrition, Vol. 116, No. 6, 2022, p. 1864-1876.

Research output: Contribution to journal › Article › Scientific › peer-review

TY - JOUR

T1 - Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries

T2 - a meta-analysis of individual participant data

AU - Liu, Enju

AU - Wang, Dongqing

AU - Darling, Anne M.

AU - Perumal, Nandita

AU - Wang, Molin

AU - Ahmed, Tahmeed

AU - Christian, Parul

AU - Dewey, Kathryn G.

AU - Kac, Gilberto

AU - Kennedy, Stephen

AU - Subramoney, Vishak

AU - Briggs, Brittany

AU - Fawzi, Wafaie W.

AU - members of the GWG Pooling Project Consortium

AU - Ashorn, Per

AU - Ashorn, Ulla

N1 - Funding Information: Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Funding Information: Members of the GWG Pooling Project Consortium: Seth Adu-Afarwuah and Anna Lartey (Department of Nutrition and Food Science, University of Ghana, Legon), Abu Ahmed Shamim and Malay Kanti Mridha (Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University), Shams Arifeen (International Center for Diarrheal Disease Research, Bangladesh), Per Ashorn and Ulla Ashorn (Center for Child, Adolescent and Maternal Health Research, Faculty of Medicine and Health Technology, Tampere University and Tampere University Hospital), Zulfiqar A Bhutta (Centre for Global Child Health, Hospital for Sick Children and Institute for Global Health & Development, The Aga Khan University), Yue Cheng (Department of Nutrition and Food Safety Research, School of Public Health, Xi'an Jiaotong University Health Science Center), Anthony M Costello (Global Health and Sustainable Development, UCL Institute for Global Health), Henrik Friis (Department of Nutrition, Exercise and Sports, University of Copenhagen), Exnevia Gomo (Faculty of Medicine and Health Sciences, University of Zimbabwe), Rebecca Grais (Epicentre, Paris), Ousmane Guindo (Epicentre Niger), K Michael Hambidge and Nancy F Krebs (University of Colorado School of Medicine), Lieven Huybregts (Department of Food Technology, Safety and Health, Ghent University and Poverty, Health and Nutrition Division, International Food Policy Research Institute), Sheila Isanaka (Epicentre, Paris and Departments of Nutrition and Global Health and Population, Harvard TH Chan School of Public Health), Patrick Kolsteren and Carl Lachat (Department of Food Technology, Safety and Health, Ghent University), Steven C LeClerq, Kerry Schulze, Keith P West Jr, and Lee Wu (Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University), Kenneth Maleta (School of Public Health and Family Medicine, College of Medicine, University of Malawi), Dharma S Manandhar [Mother and Infant Research Activities (MIRA)], Reynaldo Martorell and Usha Ramakrishnan (Hubert Department of Global Health, Rollins School of Public Health, Emory University), Susana L Matias (Department of Nutritional Sciences and Toxicology, University of California, Berkeley), Elizabeth M McClure (RTI International), Sophie E Moore (Department of Women and Children's Health, King's College London; St Thomas’ Hospital, London; and MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), David Osrin (UCL Institute for Global Health), Andrea B Pembe (Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences), Andrew M Prentice (MRC Unit The Gambia at London School of Hygiene & Tropical Medicine, Banjul), Juan Rivera (National Institute of Public Health, Mexico), Sajid Soofi (Centre of Excellence in Women and Child Health, The Aga Khan University), Willy Urassa (Department of Microbiology and Immunology, Muhimbili University of Health and Allied Sciences), and Lingxia Zeng and Zhonghai Zhu (Department of Epidemiology and Biostatistics, School of Public Health, Xi'an Jiaotong University Health Science Center). We thank Sun-Eun Lee, Jian Yan, and Karen T Cuenco at the Bill and Melinda Gates Foundation for their support of the Gestational Weight Gain Pooling Project. We thank Nita Bhandari at the Society for Applied Studies for her support as a member of the technical advisory group. The authors’ responsibilities were as follows—EL, DW, AMD, NP, MW, and WWF: designed the study (project conception, development of the overall research plan, and study oversight) with substantial input from technical advisory group members (PC, KGD, GK, SK, and TA); all members of the GWG Pooling Project Consortium: contributed data, provided feedback on the study methods and interpretation of the findings, and critically reviewed the manuscript for important intellectual content; VS, BB, and DW: provided technical support and coordination for data collection, data management, and harmonization; DW, EL, AMD, and NP: had access to the pooled data; EL: led the statistical analysis and drafted and revised the manuscript; EL and WWF: have primary responsibility for the final content; and all authors: contributed to, read, and approved the final manuscript. Data described in the article, code book, and analytic code will be made available upon request pending application and approval. Supported by Bill and Melinda Gates Foundation grant OPP1204850 (to WWF). The funder did not play a role in the study design or implementation or result interpretation. Author disclosures: The authors report no conflicts of interest. Supplemental Material, Supplemental Tables 1–3, and Supplemental Figures 1–14 are available from the “Supplementary data” link in the online posting of the article and from the same link in the online table of contents at https://academic.oup.com/ajcn/. Publisher Copyright: © 2022 American Society for Nutrition.

PY - 2022

Y1 - 2022

N2 - Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. Results: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

AB - Background: Gestational weight gain (GWG) below or above the Institute of Medicine (IOM) recommendations has been associated with adverse perinatal outcomes. Few studies have examined the effect of prenatal nutrient supplementations on GWG in low- and middle-income countries (LMICs). Objectives: We aimed to investigate the effects of multiple micronutrient supplements (MMSs) and small-quantity lipid-based nutrient supplements (LNSs) on GWG in LMICs. Methods: A 2-stage meta-analysis of individual participant data was conducted to examine the effects of MMSs (45,507 women from 14 trials) and small-quantity LNSs (6237 women from 4 trials) on GWG compared with iron and folic acid supplements only. Percentage adequacy of GWG and total weight gain at delivery were calculated according to the IOM 2009 guidelines. Binary outcomes included severely inadequate (percentage adequacy <70%), inadequate (<90%), and excessive (>125%) GWG. Results from individual trials were pooled using fixed-effects inverse-variance models. Heterogeneity was examined using I2, stratified analysis, and meta-regression. Results: MMSs resulted in a greater percentage adequacy of GWG [weighted mean difference (WMD): 0.86%; 95% CI: 0.28%, 1.44%; P < 0.01] and higher GWG at delivery (WMD: 209 g; 95% CI: 139, 280 g; P < 0.01) than among those in the control arm. Women who received MMSs had a 2.9% reduced risk of severely inadequate GWG (RR: 0.971; 95% CI: 0.956, 0.987; P < 0.01). No association was found between small-quantity LNSs and GWG percentage adequacy (WMD: 1.51%; 95% CI: −0.38%, 3.40%; P = 0.21). Neither MMSs nor small-quantity LNSs were associated with excessive GWG. Conclusions: Maternal MMSs were associated with greater GWG percentage adequacy and total GWG at delivery than was iron and folic acid only. This finding is consistent with previous results on birth outcomes and will inform policy development and local recommendations of switching routine prenatal iron and folic acid supplements to MMSs.

KW - gestational weight gain

KW - low- and middle-income countries

KW - meta-analysis

KW - multiple micronutrient supplements

KW - randomized controlled trials

KW - small-quantity lipid-based nutrient supplements

U2 - 10.1093/ajcn/nqac259

DO - 10.1093/ajcn/nqac259

M3 - Article

C2 - 36130877

AN - SCOPUS:85144589329

SN - 0002-9165

VL - 116

SP - 1864

EP - 1876

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 6

ER -

Effects of prenatal nutritional supplements on gestational weight gain in low- and middle-income countries: a meta-analysis of individual participant data

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